Acute Q Fever in an Ankylosing Spondyloarthritis Patient Treated with Etanercept.

Q fever is a rare zoonotic infection caused by Coxiella burnetii. Tumor necrosis factor-alpha (TNF-α) has an important role in the early control of this infection. However, TNF-α blockers increase the risk of infectious diseases. We present herein a patient who developed acute Q fever under anti-TNF-α who had a good evolution after anti-TNF stoppage and treatment with doxycycline.

Risk factors for ADHD and comorbid psychiatric, academic and behavior problems among primary school students in Jeddah, Saudi Arabia.

Risk factors for attention deficit hyperactivity disorder (ADHD), psychiatric, and classroom academic/behavioral problems were examined in 929 students grades 1-6 in Jeddah, Saudi Arabia. Teachers identified ADHD by completing the Vanderbilt ADHD scale. Compared to controls without ADHD, students with ADHD were more likely to have early parental loss, head trauma, motor/language delay, family psychiatric problems, and high family stress. Among those with ADHD, risk factors for psychiatric comorbidity were older age, family psychiatric history, and motor/language delay. Risk factors for impaired academic/behavioral performance were high family stress, family psychiatric problems, and chronic illness. Identifying risk factors for ADHD and common comorbidities associated with this disorder may help parents, teachers and clinicians detect this condition, increasing effective management.

Resilience among a large sample of adult Palestinians in the Gaza Strip: examining contextual sociodemographic factors and emotional response through a social-ecological lens.

OBJECTIVES: Palestinians in the Gaza Strip continue to cope with persistent violations of their social, economic, political, and civil rights. This study sought to measure resilience among adult Palestinians and its relation to contextual factors (sociodemographic variables) and emotional response using a social-ecological framework. STUDY DESIGN: Community-based, cross-sectional. METHODS: Involving 1068 households in the Gaza Strip, individuals (aged ≥18 years) completed (a) a questionnaire on demographics and social construct, (b) 25-item Connor-Davidson Resilience Scale (Cronbach alpha = .91), and (c) Positive and Negative Affect Schedule (PANAS) (Cronbach alpha = .89). Bivariate analysis, Pearson correlations, and step-wise multiple regression were conducted. RESULTS: Gazans scored significantly lower resilience compared to the normative mean in the general population (mean score = 75.9 vs. 80.4). Bivariate analysis revealed that being employed and highly educated were associated with higher resilience scores. Likewise, participants showed statistically lower positive affects (PA) (mean = 33.49, standard deviation [SD] = 7.5: 95% confidence interval [CI] 2.39-1.23, P < 0.00) and higher negative affects (NA) (mean = 22.3, SD = 7.0; 95% CI 3.68-4.73, P < 0.001) compared to normative means. Resilience scores were positively correlated with PA (r = .40, P < 0.001), with much weaker negative correlation with NA (r = -.10, P < 0.001). Only PA and NA were significant predictors of resilience (r2 = 16%); PA recorded a positive and higher beta value (beta = .38, P < 0.001) than NA (beta = -.089, P = 0.017). CONCLUSIONS: Sumud, the Palestinian notion of resilience, is an interactive process that depends on individual assets and contextual resources. Given the political turmoil and high levels of poverty, the employment opportunities must be addressed for this highly educated population to preserve resilience. Providing accessible mental health and social support services is critical.

Serum glutamate was elevated in children aged 3-10 years with autism spectrum disorders when they were compared with controls.

AIM: This study aimed to see whether measuring serum glutamate in children with autism spectrum disorder (ASD) could provide a biological marker that could allow early intervention. METHODS: Serum glutamate was measured in 30 patients aged 3-10 years presenting with ASD to the Abou El Reesh Hospitals, Cairo University, Egypt and 30 matched controls without ASD in 2015. The Vineland Social Maturity Scale was applied to assess social competence, self- help skills and adaptive behaviour in both groups. The severity of autism was measured with the Childhood Autism Rating Scale test. RESULTS: The patients' group showed higher mean values of serum glutamate (5.888) than the control group (2.521) and the statistical difference was significant (p = 0.00021). There was no significant difference (p = 0.151) in the serum level of glutamate between patients receiving 1-2 mg of risperidone (6.519 ± 2.851) and those who were free from any medication for at least six weeks (5.157 ± 2.184). CONCLUSION: We found higher levels of serum glutamate in subjects with ASD and this might reflect altered glutamatergic neurotransmission which may aid early ASD detection. Further investigations are needed with a large number of participants to further clarify the possibility of using glutamate as a biomarker for ASD.

Breast lumps in pregnant women.

Breast lumps detected during pregnancy are generally benign and reflect fibroadenoma, lactating adenoma, cysts, infarction of the breast or galactocele. Although rare, the possibility of breast cancer must also be considered to avoid any delays in diagnosis. After patient questioning and clinical examination, the first imaging modality to use is ultrasound. No further assessment is called for if lesions are categorized as BI-RADS 2 and no suspicious clinical signs are observed. Depending on the clinical setting, lesions classified BI-RADS 3 require monitoring and mammographic assessment (which can be helpful in diagnosing cancer and incurs no risk to the embryo or fetus). If the clinical signs are unclear and/or the lesion(s) are categorized as ≥ BI-RADS 4a, then mammography and often biopsy should be performed. Strict BI-RADS scoring (American College of Radiology) should be applied, bearing in mind that benign lesions can appear suspicious during pregnancy, and some cancers can exhibit what seem to be reassuring characteristics.

Female sexual dysfunction in patients with spinal cord injury: a study from Iran.

OBJECTIVES: We assess the prevalence of sexual dysfunction in patients with spinal cord injury (SCI), compare sexual function and sexual distress between female patients with SCI and gender-matched healthy controls, and address risk factors associated with sexual dysfunction among Iranian female patients with SCI. SETTING: Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. METHODS: Eligible Iranian female patients with SCI were included in this cross-sectional study. They were asked to provide sociodemographic information, and complete the Female Sexual Function Index, Hospital Anxiety and Depression Scale and Female Sexual Distress Scale-Revised questionnaire. RESULTS: Of the 105 patients participated in this study, the average age was 41.0 (s.d.=10.1) years. Women with SCI reported significantly higher levels of sexual dysfunction compared with normal controls. Approximately, 88% of SCI patients reported at least one type of sexual dysfunction, whereas only 37% of healthy controls reported sexual dysfunction. Lack of vaginal lubrication was reported more frequent in SCI patients compared with controls. Women with SCI reported a significantly higher level of sexual distress compared with healthy women. Sexual dysfunction was observed to be significantly higher in older patients, those with less education, patients with complete lesions, those with sexual distress and patients who were anxious and depressed. CONCLUSION: Sexual dysfunction is highly prevalent among Iranian women with SCI. Sexual dysfunction is associated with age, education, symptoms of depression and anxiety and level of injury. Sexual counseling during the rehabilitation period may help to prevent sexual dysfunction following SCI.